Long-term outcome of pediatric renal transplantation: a single center experience.

Renal transplantation is the optimal treatment for pediatric end-stage renal disease. We examined 51 children <20 yr old who underwent a total of 52 living-donor renal transplantations at Osaka University Hospital between 1972 and 2004. The mean age at transplantation was 13.7 (3-19 yr). The mean duration of follow-up was 16.5 yr. The five-, 10-, and 20-yr patient survival rates following renal transplantation were 94%, 90%, and 87%, respectively. The five-, 10-, and 20-yr graft survival rates were 76%, 65%, and 48%, respectively. A double-drug regimen was used before 1987; this was replaced by a triple-drug regimen including a calcineurin inhibitor in 1988. The five-, 10-, and 20-yr graft survival rates after 1988 (89%, 80%, and 60%, respectively) were higher than those before 1987. Growth was examined among patients <15 yr old at the time of surgery, and height standard deviation (SD) scores (Z-scores) were analyzed in 14 patients who displayed favorable renal function after transplantation. At the time of transplantation, mean SD score (SDS) was -2.39, and mean final adult SDS was -1.79. Rates of patient and graft survival after renal transplantation were mostly favorable. Future goals must include overcoming chronic rejection and establishing a steroid discontinuation protocol to improve growth.